| Ernesto L. Fontecha, Md, Inc | |
|
159 S Vermont Ave Los Angeles CA 90004-5904 | |
| (213) 388-2044 | |
| (213) 632-0140 |
| Full Name | Ernesto L. Fontecha, Md, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 159 S Vermont Ave, Los Angeles, California |
| Authorized Official Name and Position | Ernesto Fontecha (CEO) |
| Authorized Official Contact | 2133882044 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ernesto L. Fontecha, Md, Inc 159 S Vermont Ave Los Angeles CA 90004-5904 Ph: (213) 388-2044 | Ernesto L. Fontecha, Md, Inc 159 S Vermont Ave Los Angeles CA 90004-5904 Ph: (213) 388-2044 |
| NPI Number | 1306202833 |
|---|---|
| Provider Enumeration Date | 01/13/2016 |
| Last Update Date | 11/27/2017 |
| Medicare PECOS PAC ID | 8729383047 |
|---|---|
| Medicare Enrollment ID | O20160225000024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306202833 | NPI | - | NPPES |
| A36618 | Other | CA | MEDICAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | A36618 (California) | Primary |
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